Associations Between Stress, Psychological Capital, Well-Being, Job Burnout, and Turnover Intention Among Chinese...

The shortage of nurses is a worldwide issue. Turnover intention among nurses plays a critical role in shaping workforce stability and healthcare service quality. The inter-relationships between stress, psychological capital, job burnout, turnover intention, and well-being in nurses have not been fully clarified and warrant further study.

This study aimed to investigate how stress affects turnover intention in Chinese nurses, focusing on the serial mediation of psychological capital and job burnout and the moderation of well-being.

Using a cross-sectional study design, registered nurses were recruited from 21 hospitals in eastern, central, and western China, with 4865 valid responses collected. Stress, psychological capital, well-being, job burnout, and turnover intention were measured using validated instruments. Associations among the variables were examined using a moderated serial mediation model (PROCESS Model 91), adjusting for demographic and occupational covariates.

Stress was positively associated with turnover intention (r = 0.380, p < 0.01) and job burnout (r = 0.568, p < 0.01) but negatively associated with psychological capital (r = -0.374, p < 0.01) and well-being (r = -0.477, p < 0.01). Stress had a significant total effect on turnover intention (c = 0.290, p < 0.001), of which the direct effect (c' = 0.142, p < 0.001) accounted for 48.97% of the total effect. Psychological capital and job burnout significantly mediated this relationship. Specifically, the indirect effect through psychological capital was 0.016, accounting for 5.51% of the total effect, whereas the indirect effect through job burnout was 0.091, accounting for 31.38% of the total effect. Stress affected turnover intention through the serial mediation of psychological capital and job burnout (indirect effect = 0.041, 14.14% of the total effect). Well-being significantly moderated the association between psychological capital and job burnout, with an index of moderated mediation of -0.0008. The serial indirect effect decreased as well-being increased.

Psychological capital and job burnout represent important mechanisms linking stress to nurses' turnover intention, and well-being moderates the pathway between psychological capital and job burnout. These findings provide evidence for multidimensional interventions to reduce nurses' turnover intention, including strengthening psychological capital assessment, improving occupational well-being, and optimizing workplace support systems.

Nurse administrators should adopt comprehensive strategies addressing stress, psychological capital, well-being, and job burnout to lower nurses' turnover intention and maintain workforce stability.